Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Hypoxemia and Oxygen Delivery
Page: 2

Question 6# Print Question

Which among the following represent the changes in pulmonary respiratory parameters with aging?

A. A
B. B
C. C
D. D
E. E

Question 7# Print Question

A 62-year-old male with past medical history significant for diabetes, hypertension, hyperlipidemia, and 60 pack year smoking history comes in with complaints of respiratory distress and flu-like symptoms for the past week. Vitals are:

  • HR 105 bpm
  • BP 170/91 mm Hg
  • SpO2 87% on 5 liters per minute of oxygen via nasal cannula

He is intermittently confused but is arousable and redirectable. His arterial blood gas shows:

  • pH of 7.26
  • PaO2 of 97 mm Hg
  • PaCO2 of 61 mm Hg
  • HCO3 of 30

Which is the appropriate next step in intervention?

A. Obtain sputum culture, start broad spectrum antibiotics, and highdose steroids
B. Emergently intubate the patient
C. Initiate high flow nasal cannula at 50 L flow, 50% FiO2
D. Initiate Bi level Positive Pressure Ventilation
E. Initiate heliox

Question 8# Print Question

A 81-year-old female with history of atrial fibrillation on Coumadin, hypertension, and recent hip fracture from a fall s/p trochanteric fixation of the femoral head who has been recovering in a skilled nursing facility is brought into the emergency department (ED) with complaints of altered mental status, high fevers, and productive cough. The patient is emergently intubated because of lethargy and is transferred to the ICU. On arrival to the ICU, the patient’s vitals are HR 110 bpm, BP 90/65 mm Hg, SpO2 91% on 60% FiO2 on the ventilator. ABG is showing pH of 7.38, PaO2 of 88 mm Hg, PaCO2 of 39 mm Hg, and HCO3 of 22. Despite an increase of the FiO2 on the ventilator, increase of PEEP, and repositioning of the ETT, the patient’s oxygenation does not improve. A decision to obtain a CXR is made and the imaging obtained below:

What is the next appropriate intervention given these clinical findings?

A. Perform needle decompression of the chest
B. Advance the endotracheal tube by 3 cm
C. Change the patient position from supine to prone
D. Perform a bronchoscopy
E. Insert chest tube on the left side of the chest

Question 9# Print Question

A 92-year-old female with mild dementia, atrial fibrillation on warfarin, and hypertension presents to the ED after suffering a mechanical fall after tripping over a rug at her nursing home. Chest X-ray reveals mildly displaced right-sided rib fractures from ribs 4 through 10. Her vital signs are:

  • heart rate 92
  • blood pressure 107/71
  • SpO2 89% on 8 L face mask

Arterial blood gas obtained shows:

  • pH 7.41
  • PaO2 72
  • PaCO2 37
  • HCO3 23

The patient is mildly confused and is only oriented toward self and place. The patient is complaining of shortness of breath and rib pain with every breath and continues to take rapid shallow breaths. She is also complaining of discomfort with the face mask and attempts to remove the face mask despite redirection.

Given this clinical scenario, what would be the next appropriate clinical

A. Apply non-rebreather face mask at 10 L flow
B. Apply NIPPV with face mask (CPAP)
C. Apply Venturi mask
D. Intubate the patient
E. Apply heated and humidified high flow nasal oxygen (HFNC)

Question 10# Print Question

A 62-year-old male with past medical history significant for end stage liver disease secondary to alcohol abuse, portopulmonary syndrome, GI bleed, COPD, and type 2 diabetes presents to the ED with hematemesis. The patient is intubated for airway protection and is transferred up to the ICU for close monitoring. Gastroenterology specialists plan to perform an upper GI endoscopy to determine the etiology of the upper GI bleed. The patient is sedated on 30 mg/kg/min of propofol. The patient’s vital signs are:

  • HR 102
  • BP 92/61
  • SPO2 100%

 Ventilator settings are pressure control, tidal volume 700 mL, RR 14, FiO2 100%, PEEP 3 mm H2O. You walk into the patient’s room and notice these waveforms on the ventilator (see figure that follows). There are no ventilator or monitor alarms going off in the patient’s room.

Given these findings, what is the next appropriate step in ventilator management?

A. Lower tidal volume
B. Lower trigger threshold
C. Decrease I:E ratio
D. Decrease inspiratory flow
E. Keep the ventilator settings unchanged

Category: Critical Care Medicine-Pulmonary Disorders--->Hypoxemia and Oxygen Delivery
Page: 2 of 2